Percutaneous freezing of sensory nerves prior to total knee arthroplasty

Abstract Background Total knee arthroplasty (TKA) is a common procedure resulting in significant post-operative pain. Percutaneous cryoneurolysis targeting the infrapatellar branch of the saphenous nerve and anterior femoral cutaneous nerve could relieve post-operative knee pain by temporarily block...

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Bibliographic Details
Published in:The knee 2016-06, Vol.23 (3), p.523-528
Main Authors: Dasa, Vinod, Lensing, Gabriel, Parsons, Miles, Harris, Justin, Volaufova, Julia, Bliss, Ryan
Format: Article
Language:English
Subjects:
Aged
Arthritis
Arthroplasty, Replacement, Knee
Cold
Cryoneurolysis
Cryosurgery - methods
Denervation - methods
Female
Freezing
Humans
Joint surgery
Knee - innervation
Knee Joint - innervation
Knee Joint - surgery
Length of hospital stay
Male
Middle Aged
Orthopedics
Osteoarthritis, Knee - surgery
Pain control
Pain management
Pain, Postoperative - surgery
Peripheral Nerves - surgery
Postoperative period
Retrospective Studies
Surgical outcomes
Total knee arthroplasty
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Summary:Abstract Background Total knee arthroplasty (TKA) is a common procedure resulting in significant post-operative pain. Percutaneous cryoneurolysis targeting the infrapatellar branch of the saphenous nerve and anterior femoral cutaneous nerve could relieve post-operative knee pain by temporarily blocking sensory nerve conduction. Methods A retrospective chart review of 100 patients who underwent TKA was conducted to assess the value of adding perioperative cryoneurolysis to a multimodal pain management program. The treatment group consisted of the first 50 patients consecutively treated after the practice introduced perioperative (five days prior to surgery) cryoneurolysis as part of its standard pain management protocol. The control group consisted of the 50 patients treated before cryoneurolysis was introduced. Outcomes included hospital length of stay (LOS), post-operative opioid requirements, and patient-reported outcomes of pain and function. Results A significantly lower proportion of patients in the treatment group had a LOS of ≥ 2 days compared with the control group (6% vs. 67%, p < 0.0001) and required 45% less opioids during the first 12 weeks after surgery. The treatment group reported a statistically significant reduction in symptoms at the six- and 12-week follow-up compared with the control group and within-group significant reductions in pain intensity and pain interference at two- and six-week follow-up, respectively. Conclusions Perioperative cryoneurolysis in combination with multimodal pain management may significantly improve outcomes in patients undergoing TKA. Promising results from this preliminary retrospective study warrant further investigation of this novel treatment in prospective, randomized trials. Level of evidence III
ISSN:0968-0160
1873-5800
DOI:10.1016/j.knee.2016.01.011